health7, community health

health7, community health

http://www.yourdomain.com/healthcommunity

health7, community health

Health7, community health

Health community includes areas that are fruitful for improving people''s wellbeing. Health-community-health, care is described as that care that can be reached by the majority. This includes areas that are most fruitful for improving people’s well-being, physically, culturally, social aspect, environment and related mental health.

The areas include definition, health-system, school-health coordination, organization, health-education, and health media among others.

Community-health is the act of preventing diseases, prolonging and promoting health through efficiency, organized-efforts by medical and nursing services. This is an art and science of taking care in all its aspects improving care of living.

DEFINITION OF COMMUNITY -HEALTH

Health in community-health is defined as a systematic way of studying health and diseases present in a community and also the patterns of delivery- care, both of which also influences the amount and nature of disease. It is alo known as community- medicine. It is also known as a field concerned with the study of health and disease in human-population. Again in some settings it is referred to as population-medicine, preventive- medicine or social medicine.The goal is to identify the totality of health-problems and needs of defined population and also to defined-population. This also considers mechanisms by which these needs are or should be met.It is a contrast to clinical-medicine, which focuses largely on the care of individuals. This focuses primarily on groups of individuals, or the community and is mainly concerned with the evaluating the health of all members in a defined community, including those who do not seek help .

Definition of Community- Health

This is the science and the art of preventing diseases, prolonging life, and promoting health by C.E.A Winslow (1920) and also increasing efficiency through organized effort for:This includes:- The sanitation of the environment,The control of communicable-diseases,The education of individuals on personal hygiene,The organization of medical and nursing-services for the early diagnosis and preventive treatment of the disease,The development of social machinery so as to enable every citizen his birth right of health and longevity to ensure every individual a standard of living, also adequate enough for the maintenance of good -health,It is an art and science of taking- care of health in all its aspects of life which also include promotion and preservation of health, prevention of diseases through:-Maintaining good-sanitation, portable-water supply,To provide health- education to self-care nutrition and others,It helps in controlling communicable and non –communicable diseases,By organizing proper medical and nursing-services and alsoImproving the standard of living with the help of other sectors and active-involvement of beneficiaries and other community- members.According to WHO, it refers to the health-status of the members of the community, to the problems affecting their health and to the totality of health- care that is to provide the community.

Community and Health

It is described as one of the most fruitful areas, for improving the health of the people. It is a fact that social, physical and cultural- aspect of the community has a major influence on an individual’s- health status. Also, the social environment is important since social- problems and social supports are directly related to physical and mental illness. Physical- environment is important since physical-problems like air, water and soil-pollution leads to various diseases in human- being. Also the cultural environment which include food, patterns and life-style, also have major implications for health. The community-health-nurse and also other professionals must actively consider the influence of the community on the health -status of a patient. Most importantly he needs to become involved in influencing the structure and functioning of system within\ the community. A focus on preserving and promoting-health also preventing-illness for all people in the community will not only have an impact on health of the identified-client, but will also reach the lives of numerous people who are not in the health-care-systems. It is important to review the community to get acquainted with its concepts.

Meaning and definition of community

The term community suggests a shared- pattern of feelings, behavior and life-styles together with close and frequent personal-relationship with other people. The knowledge, values beliefs and behaviors of given groups have a major -implication for well-being, morbidity and mortality.Community is also described as a local-area over which people are using the same language, conforming to the same feelings. The more or less the same sentiments and also acting upon the same attitudes. A community is a social -group of any size whose members reside in a specific-locality, and share a government and have a common- culture and historical-heritage.Sanders viewed this in three- ways-: as a place, as a social- system and as a collection of people.It is a place, and then the environment, housing, transportation etc. are all related to geographical-location as are population- composition and distribution, health-services, resources and services.It is a social-system because community is combination of all the social- units and systems which have been developed to carry out its major-functions with its pattern of interaction.Community is a collection of people, where the health-workers will find both individuals who are well (healthy) and who are ill (unhealthy). The statistical-data of the people will help the health- authority to plan and implement health -schemes to attain health of its citizens.Again World-Health-Organization defines “community” as a social- group determined by geographical- boundaries and/or common-values and interests. Its members know and interact with each other. It functions within a particular social structure and exhibits and created norms, values and social interactions.

A community may be defined “as a group of inhabitants living- together in a somewhat localized-area under the same general- regulations and having common-interest, functions, needs and organization.” It goes beyond city, village and people -defined by relationships between people as well as physical-contours.The community is seen as a social- unit, wherein we find transaction of a common-life among people who compose the unit. According to this definition, the whole-country may be viewed as a “community.”

Definition of Health- Well-Being:-

It is a state of well-being of individual and community; so it can be examined at individual or community-level. For individual the term, “health” refers to the optimal- functioning of the individual, absence of disease, illness, impairment or injury. In the context of the community it refers to various objectives. Measure of health-status or health-indices like incidence of prevalence of disease-applied to different segments of population.

The definition of health-range on a continuum from the absence of disease to optimal-functioning to utopian-ideals of complete- state of physical, mental, emotional-spiritual and social-well-being.H.S. Hayman defines it as a state of feeling-sound in body, mind and spirit, with a sense of reserve- power. This perception of health is based on normal- functioning of the body’s physiological-process, understanding the principles of healthful- living and attitude that regards health not only as a means of survival and self-fulfilling in itself, but as means of creative social- adjustment and a richer, fuller life as measured in constructive service to mankind.H. Blun defines “health” as the person’s capacity to function in a way to maximize potential to maintain a balance appropriate to age ‘and social-needs to be reasonably-free of gross- dissatisfaction, discomfort, disease- or disability, and to behave in ways that promote-survival as well as self-fulfillment or enjoyment.R. Dubiois views health as adaptation or a function of adjustment.“Health” is the achievement of a state of harmony between mans internal and external milieu (Liverpool school of Tropical Medicine).F. and E. Rathbore formulates health as a wholeness of function movement towards self-actualization relating to effective, creative-use of potential, realistic-interpretation of experience and coordination of attitudinal-physiological and behavioral-adaptations.Imogene King defined ‘health’ as a dynamic-state of life cycle of an organism that implies continuous -adaptation to stresses in the internal and external-environment through optimum -use of one’s resources to achieve maximum potential for daily living.S. Perkin defines it as state of relative-equilibrium of body form and function which result from its successful dynamic- adjustment to force tending to disturb it. Perkin puts his definition as not passive-interplay between body -substances and forces- infringing upon it but an active -response of the body- forces working towards adjustment.According to Dunn Health is high-level of wellness. Dunn equates health as a state-of-health within an individual and ability-to- control his environment; he defines it as a state-of -completeness-of-emotional, mental and physical-strength enabling the person to get goals investigate-alternatives, make decisions and take actions to control- environment.WHO defines health as a state of complete -physical, mental, social and spiritual well-being and not merely-absence of diseases.

Community- Health -Nursing

This is described by "The American Nurses Association (ANA 1980)" defined as “community-health-nursing” is a synthesis of nursing and public health-practice applied to promoting and preserving the health of people. Community-health-practice is general and comprehensive and is not limited to a particular- age-group or diagnosis, and is continuing, and not episodic. It is is a dominant-responsibility to the people as whole, nursing -directed to individuals, families or groups contribute to the total-population. Health- education, promoting, maintenance and management, coordination and continuity of health -care are also utilized in a holistic- approach to the management of the health-care of individuals, families and also in a community. This actions acknowledge the need for comprehensive-health-planning, they also recognize the influences of social and ecological- issues give attention to populations which are at risk, and utilize dynamic-forces which would influence-change.In this definition community- health encompasses both direct and indirect -services to individuals, families, groups and communities. The scope of community- health is to concern with both wellness and illness in providing, as well as facilitating the delivery -of -services. Community-health-nursing also requires the integration of many-general-areas-within-nursing, such as the nursing-process, interpersonal-skill and leadership- principles. It further necessitates the useful of specific-content from other practice -areas, such as medical, surgical, pediatric, and obstetric and gynecology, physiatric mental- health -nursing. Community-health also has specialized-body of knowledge pertaining to areas like as public-health-science, health-policy and also include community-dynamic.

A description or definition of community-health-nursing should be based on an understanding and appreciation of the active spectrum of nursing. Virginian Handerson considers the function of present days-nurse to be unique, to assist the individual, sick or well, in the performance of those activities- contributing to health or its recovery (or peaceful- death) that he would perform if he had the necessary-strength, will or knowledge. Community-health-nurse will do these in such a way as to help him gain independence as rapidly as possible.

Community-health-nursing is the field-of-nursing in which the family and community are the patient. Although it is a concern with the total- health – illness- spectrum, its primarily-focus in on the prevention of diseases and the promotion and also the maintenance of the highest level of health and well– being. The community-health-nurse works collaboratively with families and groups in identifying their health-problems and nursing-needs in determining the nursing-care-plan in mobilizing appropriate community-resources and in evaluating the nursing-services rendered by other-members of the nursing-team.The community health-nurse also practices with professional and lay persons in identifying the factors with the community- relevant to health. She also collaborates in planning, implementing and evaluating the community-health- programs, and also assumes leadership in interpreting- nursing and defining- nursing-needs.

Other Definitions

Community- health-nursing is a synthesis of both public-health- science and nursing-science. It is theoretically-responsive to our prevailing -ideas of social-justice and the methods of disturbing- health -care -resources as chosen by the community.Community -health -nursing is also described as a learning practice -discipline with ultimate goals of contributing, individuals and in collaboration with others to the promotion of patients, optimum-level of functioning through teaching- delivery-of-care.This definition acknowledges that community -health-nursing- efforts are directed towards all people, whether they are cared for as individuals, as part of a family, in a community or as a community at large. This definition emphasizes multi-disciplinary -role for the successful implementation of public health- practice and which focuses on the increasing- priority of health- promotion. So, community- health-nursing is practices that is continuing and comprehensive and also directed towards all age-groups, takes place in a wide variety of settings and include health-education, health -maintenance, coordination and evaluation of individuals, families, groups and communities.

The western interstate commission on higher-education on nursing include additional-component to a definition of community- health-nursing. The group says, community- health-nursing is the engagement of community- health- nurse with other people in a mean and action towards higher level of wellness in individuals, families and communities. This definition recognizes the involvement of the nurse with others to meet the goals of higher-level of wellness. This may involve working with other health- team members to provide care, either directly on families and groups who need health-care or by means of consultations or referrals. Community-health-nurse involves working with an including families and groups and the planning and implementing of the changing- process.So, community- health-nursing is the integrated -knowledge of nursing and public- health -science applied to all human- beings for promotion, preservation, maintenance and restoration of health, and also prevention of illness by providing direct- care or referral-services and education in collaboration with other members of the health -team by involving the community to achieve the goal of health for all.We also understand that community-health-nursing is the synthesis of public-health-science and nursing-science. Health promotes the preservation of health and motivates populations to see and maintain a high- level of wellness. Community-health-nursing focuses upon the total-population and nursing -activities which are directed towards individuals and groups, valid only as they contribute to health of total-community.Dunn, defines higher-level of wellness as “an integrated- method of functioning which is oriented toward maximizing the potential of which the individual is capable of. This requires that a ‘man’ maintains a continuum of balance and also purposeful direction within the environment where he is functioning” Dunn views the concept as equally appropriate when viewing family or community as a system to the system which will be individual, family or community-maximize its potential and maintain a continuum of balance, community -health -nurses must assess the system, location on the health -continuum and also the factors influencing its location as a basis for intervention.

If the system is temporarily-imbalanced, then primary- prevention may assist the system to maintain its health and balance or to attain a higher level of health. Then, if the system is temporarily out balance, secondary or tertiary- prevention-intervention may assist the system to regain its balance and health.Higher levels of wellness may result from a wide spectrum of community -health -nursing -activities such as community- teaching, counseling or motivating people, manipulating the environment, giving physical- care and emotional- support, re-socializing or convalescing- patient, or by organizing community- groups. Environmental-Health:-

Community-health-workers are Government-agencies; they are also officialagencies operating at the local, state, federal and international-levels. They are tax supported, and their functions are mandated by law, and they emphasize health- promotion, disease-prevention and care of the environment as a whole. They are accountable to citizens and government through an official appointed or an elected-board. All these include the overall framework of community- health-care-delivery in the official-health-agencies at different levels-National, state and District. All these combined and with international- health, it is possible to have a strong-global-health and environmental- program that is effective. When a community-worker is doing environmental-health-work, he needs to consider many factors. These include understanding people and their environment, behavior, environment and health. He must also include individuals, the family, the community and health facility and the community as a whole.

Factors that affect Health

Factors that affect it include:-disease, ignorance and poverty are, together, are the cause of much suffering, and if medical-workers are to deal with disease, they will also need to understand about ignorance and poverty. To help people in their daily-lives, they need to understand human-behavior and the surroundings in which people live, as both of these influence whether people stay healthy or get sick. Changes for the better can only be made if we understand people’s behavior and how they organize themselves as individuals, in small-groups like the family, and within larger communities.The community worker is also human and needs to be understood by those whom he works for. He must understand, his culture and education, the community that he lives in, his family and friends; his medical-training, his patients and how he fits into the health-services. All these influence his behaviour, his work-pattern and how effective he and his staff will be when working with the community.

Understanding People and their Environment:-

Understanding people and their environment, there are many ways of looking at people’s- behaviour and also how they are organized. Anthropologists and psychologist may be able to explain individual and group-behaviour, sociologists-deal with how society is organized. Geographers have their own-role and they can tell us how people fit into and use land, the other groups like political-scientists and historians contribute to understanding of society. Community workers need to consider all the important influences that affect an individual, the family and the community as a whole. The environment is an important part of human life and behavior. Within the environment are many influences e.g. biological, physical, social and economic. All these have a bearing on how people live and behave. In turn, the way people live and behave determines the diseases from which they suffer from, and how effectively the health-services work.The biological-environment is made up of all living things that include:-People, Vegetation, such as trees, grass and crops,Insects, such as mosquitoes and houseflies and also Infective organisms, such as amoeba, bilharzias and tetanus.The physical environment is made up of all the geographical, physical and chemical-features and these include:-The land-mountains, valleys, plains,and type of soil and water,Climate, altitude, chemical and toxic-substances.The cultural and social-environment is made up of all the customs, beliefs and organization in society, these include:-Family and kinships,Customs and beliefs, Religions and Leadership and power-tructure,The economic and political environment is made up of work, money and government,Local-community-organization and self-reliance,Rural and urban-services,Political organization,Development policies,People are affected by their environment, and can change it if they want to, as this is largely what development is all about. The environment can be changed to make it healthier. However, if the local-community is not consulted, environmental -changes can make things worse and introduce new health-problems.The multiple-interactions between people, diseases and environment are called ecology. These make a community -healthy or unhealthy. Biological to physical could mean that in some areas there is over-grazing or charcoal- burning (biological) resulting in soil-erosion and the creation of a desert (physical); this is degrading the environment, which in turn, affects the life of the community. Today “environmental- degradation” is a major problem. Ecology is the study of the balance of all these factors.

Behavior, Environment and Health:-

Behavior ,environment and health and the following factors illustrate the connections between human behavior and environmental-influences that community-health-worker needs to know e.g.Malnutrition in young children is common in many areas of Africa and this is due to an inadequate-diet, e.g. not enough-food or a lack of protein. For example, eggs, which contain proteins however, often they are not given to young-children as they are believed to cause sterility. This shows how customs and beliefs (or the cultural and social -environment affect human-health.There is another example of using unavailable -resources during demonstrations in clinical-areas. Community-health-workers prepare baby food on a paraffin- stove while it is clear that the stove is not within their reach, as the mothers cannot afford it. This is an example of the effect of the economic- environment. Similarly, health-education in schools on the value of beans as a plant source of protein is useless if the local soil and weather condition (i.e. physical environment) are unsuitable for growing them.Children frequently die from dehydration caused by severe- diarrhoea. Many of these deaths would not occur if the sick child was fed from a cup rather than a bottle, or if the drinking-water came from a protected-well rather than an open pond. These are combined environmental-influences-cultural and social, and biological. But people find it hard to change their behavior.In some costal areas attendance at MCH clinics was poor. The clinics, held regularly under a large mango-tree, were well run by an unmarried -trained -nurse. It was then pointed out that married -coastal-women generally do not discuss pregnancy and childbirth with young- unmarried-women, and certainly would not look to them for advice. It is also very much against their custom for pregnant -women to gather in the open where they might be seen by the men of the village. The attendance would be better if the clinic was run by an older-married-community- health-nurse and held in an enclosed area (This is an example of the effects of the social and cultural environment).The habits of vectors determine the distribution of many diseases. For instance, malaria-carrying -mosquitoes do not regularly breed at altitude above about 1,500 metres (approximately 5,000 feet). Malaria is therefore usually found below this level. Schistosomiasis may be introduced and spread where it did not previously exist when irrigation-schemes are started for crops such as sugar-cane (this example combines several environmental factors, biological, physical and economic).The way people use the health-services is also important. For example, some patients with tuberculosis never come for treatment and therefore many of them die of their disease without attending health-centre or hospital. Many of those seek and start treatment never complete it (this is an example of the social and cultural- environment). People will only use services appropriately when their interest in health-problems is encouraged and they are invited to join in planning the necessary-services.

Individuals

Individuals are unique; however they share behavioral characteristics with other people who are part of a particular- culture. Culture is all those things which people learn, share and pass on to later generations. One of the most important of these things is language, and there are many languages in Africa. The community-health -worker must be able to communicate, and when he is working in an area where a language other than his own is spoken, knowledge of that language will be vital to his work. It is important to be able to show respect and understanding for other people and their culture as well as merely knowing the local greetings.We learn our beliefs and customs about right and wrong-behavior as we grow up. For example, young-people growing up in some rural-areas are taught that dead-ancestors can influence the lives of living-people.If the ancestor becomes angry because of bad behavior, they can cause misfortunes. Some practices and beliefs about sickness and health are related to these beliefs in ancestors or in the power of people to perform witchcraft. In telling people about the effects of germs and bad foods on health, we may convince some of them but others are more likely to follow their traditional -beliefs than any new ideas. Sometimes people will follow both sets of ideas in the old and new. For instance, they will consult a community-health -worker for treatment of the symptoms and return to the traditional- healer to get rid of what they think is the “real” cause of the illness.There are ideas of political-significance as well individuals- need to know about traditional-beliefs and customs concerning leadership of the community (e.g. religious, political), how decisions are reached (e.g. individual choice, family influence, meeting of elders, local courts), and local debates and disagreements that rise because the society is developing and changing.

The Family:-

The family teaches their children basic education in language, beliefs and customs from their families, who also provide the children with food, clothing and shelter. The family begins with some form of recognized marriage in which husbands and wives have certain rights and obligations. Though things are changing, and in some places there are great pressures for “women’s right” in many communities the woman is still regarded as the subordinate partner. This had important effects on health behavior and the use of the health services. There is very little use in educating -women about better -foods and cooking-practices if their husbands will not accept the social -changes that will allow women to put them into effect. And without this acceptance of social-change, women may not be free to, or take their children to a health -centre, even if they want to.Beliefs about sexual-relations within and outside-marriage are often strongly held and are usually related to the value of children in the community. Traditional-beliefs about abstinence from sexual-intercourse, simple contraceptives methods and spacing of children are not being practiced so much now and consequently many more children are born to young -unmarried girls with little spacing between births. The spread of sexually transmitted-diseases (STDs) including AIDS is also largely determined by the pattern of sexual-relations in the community.The extended-family includes relatives other than the man, woman and their children (the nuclear family) and there are many rights and obligations expected by and from each-member of its members of the family. Since children grow up as members of a large -group, the attitudes and ideas of this wider family are important. Children may be sent to live with different relatives, outside the nuclear-family. Food and incomes are commonly-shared with the extended-family and accommodation may have to be provided for travelers and relatives looking for work. While these customs have worked well in a largely rural and subsistence-economy, they are currently under great strain as more of the population more to the towns and accommodation and work become more difficult to obtain.There can be a simple conflict within the extended-family; this is normal, but when it becomes serious the family may become disrupted. The situation changes over time, when a man and woman marry and before they have children, their economic and social- position is different from when they have children, and from when these children grow up, move away and have their own families. Important-changes are now taking place that will have profound effects on individuals,family and the whole-community. The population is growing rapidly, more people are moving to the towns and overcrowding is increasing. People are living together so there are more old people. With wars and the AIDS-epidemic there are rapidly increasing number of orphans.

The Community:-

Communities are groups of people who live in a particular place such as a village, and who have common- interest in what happens there.In a typical rural- community, where everyone knows everyone else, there is a strong sense of all belonging together. Tradition and public-opinion in a rural-community are very important and people are careful to behave in a way that meets with community approval.To understand the community’s-traditions, it is important to know how people live, about the types of farming they practice and the division of labour. Growing bananas or raising cattle have an almost constant pattern of work throughout the year, while crops such as maize; millet, cotton and tobacco are grown in a single rainy season. In many areas men prepare the land but the planting is done by women, who also collect firewood and water, do the cooking and care for children. The farming season in these areas have an effect on health. There are times when all the family members are busy cultivating, but after the harvest there is little to do. There are hungry times before the harvest times when the rains lead to increased illness.Cash crops and cash markets tend to bring about differences in wealth between families in the same community and between more and less fertile areas. In the semi-arid lands, many people generally the men tend to travel long distances to become labourers on tea estates or to work in mines. Wealthier- farmers, with more land and machinery, generally use the health- services more than landless-labourers whose health-needs may be greater. These differences become greater when there is a shortage of land.Generally, rural-communities have some kind of leaders with authority. The health worker needs to know who the leaders are, and what their authority rests. Religious leaders may be influential in the local mosque or church, any may also be powerful in the local-community. The leading-elders may be influential in some matters. The health worker, like the teacher, is also a local leader and can be very influential.In urban-communities there are many people who have left their rural-homes and come to town in search of work. Some have found work but many have not. The towns have grown much faster than they can provide jobs or even the basic services of shelter, water and sanitation. Squatter areas have multiplied and present one of the most urgent and difficult social and health- problems. Health-facilities may be nearer but are generally overcrowded. Most urban-dwellers work away from where they live, so there is not such strong sense of belonging together. Children have less room to play, and so roam the streets. Family and public-opinion have less effect on behavior; violence and crime are commoner.The urban- working environment, especially when large groups of workers are in one place, also provides new experiences. Organizations usually have set of rules governing what may or may not be done by different employees, some of whom have responsibility for directing and controlling the work of others.Patterns of leadership and authority do exist in the urban- community but are not so clearly defined as in rural -areas. In the absence of traditional-elders and leaders, organizations such as religious groups, women’s groups and football clubs play a role in bringing people together.Conflicts between groups of people are a normal feature of communities. Conflict may be based on personal-ambitions or on different viewpoints about local affairs. For instance, in which village should a new dispensary be placed, or where should a new well is dug? Conflict may also arise over exploitation of one group by another, e.g. labourers by employees, or tenants by landlords. Health-workers as leaders may be required to help in setting conflicts and solving exploitation -problems.

The Health Centre and the Community:-

Health -workers, by working together with the community, can play an important role in development in the area.The health-centre and its staff are, in itself, an organization or community. It has one person in overall charge with other people working under her direction. A person in a subordinate- job can sometimes feel he is not appreciated or listened to. In health, as in all services, it is important not to waste- manpower through inefficient organization. The positions of all members of the health-team must be appreciated to make their work satisfying and meaningful. A good health-team helps the community more than a number of individuals working separately.An early requirement for a newly arrived health-workers is to identify and understand local beliefs and customs. Local-people of all ages can help to explain local-beliefs and customs and how they affect health. Beliefs and customs that relate to different “stage” in life-pregnancy, childbirth, infancy, childhood, adulthood, old age and death should be studied e.g.Those that promote health.Those that probably do not affect health very muchThose that may cause ill health and disease.Breaking down beliefs and customs have effects on the family and community; what effects, have on the health of the individual. As people from different areas have different traditions, it is important to know the main cultural groups in the health-centre’s population.

The Environment:-

Four main aspects of environment namely the biological, physical, cultural and social, and economic and political have already been discussed. When the health worker starts working in a new area, these will help her to obtain in a map of the area and to note, or mark in, the important physical-features of the environment.The hills and valleys, lakes and rivers, roads and bridges and any major features affecting-communicationThe villages and main settlementsThe health-centres, dispensaries and mobile clinic centres and drawing 5 Km and 10 Km cicles on each.“The catchment area” of the health-centre.It is also useful to know:-The local-leaders and the power-structure.The main cultural and social-events of the year.The local-climate and rainfall patterns.Farming-seasons and the trading of food itemsWater sources.Local disease vectors and animal reservoirs.

Working with Community:-

The health-worker must have good relations and should be established with the government and the local and political leaders. They may be able to pinpoint matters of local importance. Attending meetings of local development or health- committees, although time consuming, is a useful way to get to know the local leaders and for them to develop respect for the advice and help the health staff can give the community.Where community-based-health-programs are being developed, it is essential that village-health or development committees (VHCs or VDCs) be established. The community should select about ten members, with representatives from all factions:- the local authority, elders, churches, women’s groups, youth-groups, teachers, shop keepers etc. With some guidance (even training) from the health staff, such committees can play a key role in developing sustaining community-health-programs.Apart from formal-relations with officials, an informal friendly cooperation with individual members of the community at all levels will facilitate work in the community.

Other Factors that Affect Health:-

The other factors that affect health are man-made or they exist because of men and they include:-General:-An activity out of character with its surroundings:-Any structure of a scale not in keeping with its surrounding; and major changes in land use.

Urban Development Including:-

Designation of new township; establishment of industrial estates; establishment or expansion of recreational areas; establishment or expansion of recreational townships in mountain areas, national parks and game reserves; and shopping centers and complexes.

Transportation including:-

All major -roads; all roads in scenic, wooded or mountainous areas and wetlands; railway-lines; airports and airfields; oil and gas- pipelines; and water transport.Dams, rivers and water-resources includingStorage-dams, barrages and piers; river-diversions and water transfer between catchments; flood-control-schemes; and drilling for the purpose of utilizing ground water-resources including geothermal energy.

Aerial spraying:-

Mining, including quarrying and open-cast extraction of precious metals; gemstones; metallieferous ores; coal; phosphates; limestone and dolomite; stone and state; aggregates, sand and gravel; clay; exploitation for the production of petroleum in any forms; and extracting alluvial gold with use of mercury.Forestry-related-activities including: timber-harvesting, clearance of forest-areas; reforestation and afforestation.Agriculture including:- large-scale agriculture; use of pesticides; introduction of new crops and animals; and use of fertilizers; irrigation.

The urban- working environment, especially when large groups of workers are in one place, also provides new experiences. Organizations usually have set of rules governing what may or may not be done by different employees, some of whom have responsibility for directing and controlling the work of others.Patterns of leadership and authority do exist in the urban- community but are not so clearly defined as in rural-areas. In the absence of traditional elders and leaders, organizations such as religious-groups, women’s-groups and football -club play a role in bringing people together.Conflicts between groups of people are a normal-feature of communities. Conflict may be based on personal ambitions or on different viewpoints about local affairs. For instance, in which village should a new dispensary be placed, or where should a new well is dug? Conflict may also arise over exploitation of one group by another, e.g.labourers by employees, or tenants by landlords. Health-workers as leaders may be required to help in setting conflicts and solving exploitation- problems.

The Health Centre and the Community:-

Health-workers, by working together with the community, can play an important role in development in the area.The health-centre and its staff are, in itself, an organization or community. It has one person in overall charge with other people working under her direction. A person in a subordinate- job can sometimes feel he is not appreciated or listened to. In health, as in all services, it is important not to waste manpower through inefficient organization. The positions of all members of the health-team must be appreciated to make their work satisfying and meaningful. A good-health team helps the community more than a number of individuals working separately.An early requirement for a newly arrived health-workers is to identify and understand local beliefs and customs. Local-people of all ages can help to explain local-beliefs and customs and how they affect health. Beliefs and customs that relate to different “stage” in life-pregnancy, childbirth, infancy, childhood, adulthood, old age and death should be studied e.g.Those that promote healthThose that probably do not affect health very muchThose that may cause ill health and disease.Breaking down beliefs and customs have effects on the family and community; what effects, have on the health of the individual. As people from different areas have different traditions, it is important to know the main cultural groups in the health- centre’s population.

The Environment:-

Four main aspects of environment namely the biological, physical, cultural and social, and economic and political have already been discussed. When the health worker starts working in a new area, these will help her to obtain in a map of the area and to note, or mark in, the important physical-features of the environment.The hills and valleys, lakes and rivers, roads and bridges and any major features affecting communicationThe villages and main settlementsThe health-centres, dispensaries and mobile clinic centres and drawing 5 Km and 10 Km cicles on each.“The catchment area” of the health -centre.It is also useful to know:-The local-leaders and the power structure.The main cultural and social events of the year.The local climate and rainfall-patterns.Farming seasons and the trading of food itemsWater sources.Local disease- vectors and animal reservoirs.

Working with Community

The health-worker must have good relations and should be established with the government and the local and political leaders. They may be able to pinpoint matters of local importance. Attending meetings of local development or health- committees, although time-consuming, is a useful way to get to know the local leaders and for them to develop respect for the advice and help the health-staff can give the community.Where community-based health -programs are being developed, it is essential that village-health or development-committees (VHCs or VDCs) be established. The community should select about ten members, with representatives from all factions the local authority, elders, churches, women’s-groups, youth-groups, teachers, shop keepers etc. With some guidance (even training) from the health-staff, such committees can play a key role in developing sustaining-community-health-programs.Apart from formal-relations with officials, an informal friendly cooperation with individual-members of the community at all levels will facilitate work in the community.

Other Factors that Affect Health:-

The other factors that affect health are man-made or they exist because of men and they include:General:-An activity out of character with its surroundingsAny structure of a scale not in keeping with its surrounding; and major changes in land use.

Urban -Development Including:-

Designation of new township; establishment of industrial estates; establishment or expansion of recreational-areas; establishment or expansion of recreational townships in mountain areas, national-parks and game-reserves; and shopping-centers and complexes.

Transportation including:

All major roads; all roads in scenic, wooded or mountainous areas and wetlands; railway-lines; airports and airfields; oil and gas pipelines; and water- transport.Dams, rivers and water resources includingStorage dams, barrages and piers; river diversions and water transfer between catchments; flood-control-schemes; and drilling for the purpose of utilizing ground-water-resources including geothermal energy.